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Host-modifying drugs against COVID-19: some successes, but not yet the breakthrough

Harald Brüssow1

  • 1Department of Biosystems, Laboratory of Gene Technology, KU Leuven, Leuven, Belgium.

Environmental Microbiology
|November 3, 2021
PubMed

Insights

Host-modifying drugs show varied COVID-19 benefits. Immunomodulators like tocilizumab and anakinra offer specific advantages, while dexamethasone and baricitinib benefit distinct patient groups, highlighting a need for targeted therapies.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Pharmacology

Background:

  • COVID-19 treatment has explored various drug classes, including antivirals and host-modifying agents.
  • Host-modifying drugs aim to modulate the immune response or inflammatory pathways in COVID-19 patients.
  • Previous reviews have covered antiviral drugs, necessitating a summary of host-modifying drug trial outcomes.

Purpose of the Study:

  • To review and summarize clinical trial results of host-modifying drugs in COVID-19 patients.
  • To evaluate the efficacy and identify patient subgroups or infection stages benefiting from specific immunomodulators.
  • To assess the overall landscape of host-modifying therapies and identify unmet needs in COVID-19 treatment.

Main Methods:

  • Systematic review and meta-analysis of published clinical trials involving host-modifying drugs for COVID-19.
  • Analysis of outcomes including clinical benefits, survival rates, and subgroup efficacy.
  • Comparison of different drug classes such as immunomodulators, anti-inflammatories, anticoagulants, and antibiotics.

Main Results:

  • Immunomodulators like tocilizumab and anakinra showed variable benefits, often dependent on patient subgroups or disease severity (e.g., hyperinflammation).
  • Anti-inflammatory Janus kinase inhibitor baricitinib demonstrated benefit in non-hypoxic hospitalized patients, while corticosteroid dexamethasone reduced mortality in ventilated or oxygen-dependent patients.
  • Therapeutic anticoagulation showed a survival benefit in non-severe cases, whereas colchicine and azithromycin had limited or no observed survival benefits.

Conclusions:

  • Host-modifying drugs demonstrate varied clinical benefits in COVID-19, with efficacy often linked to specific patient profiles and disease stages.
  • Current repurposed drugs show limitations, underscoring the urgent need for novel therapeutics targeting SARS-CoV-2 or COVID-19-specific pathologies.
  • Further research should focus on developing targeted therapies rather than relying solely on repurposed agents for effective COVID-19 management.

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